This issue of the Journal of Perinatal & Neonatal Nursing focuses on quality indicators and measurement, an integral component of improving perinatal and neonatal health outcomes and care in the United States (US). An effective response to the untenably high rates of maternal and infant mortality and morbidity and unjust racial inequity, which mark our current system, depends heavily on quality measurement and reporting strategies to guide practice and policy decisions. At the time of this issue's publication, a critical part of the package of bills, titled the Black Maternal Health Momnibus Act of 2021, calls for investments to improvements in data collection processes and quality measures to help better understand the causes of the maternal health crisis in the United States and inform sustained solutions. The perinatal section of this issue presents a timely selection of 5 articles focused on breastfeeding, midwifery care, childbirth education, severe maternal morbidity (SMM), and disparities in birth outcomes, using data derived from a range of sources, collectively highlighting the value and need for robust data collection and quality measures to improve perinatal care.
The first of the perinatal articles, titled "Breastfeeding as a Quality Measure: Demonstrating Levers of the National Quality Strategy," by Jolles et al makes innovative use of secondary data from 2 national sources to demonstrate how breastfeeding rates have improved over time with the implementation of the core functions of the National Quality Strategy-measurement and feedback, public reporting, certification, and technical assistance. The Cathy Emeis and colleagues study, titled "The American College of Nurse Midwives Benchmarking Project: A Demonstration of Professional Preservation and Improvement," adds to the growing literature on midwifery's contribution to optimizing perinatal outcomes. This work provides a comprehensive overview of the American College of Nurse-Midwives benchmarking process and the relevance to quality improvement and certified nurse-midwifery standards in the United States. The data presented in the Vanderlaan et al study, titled "Association of Delivery Outcomes With Number of Childbirth Education Sessions," a secondary data analysis from the First Birth Study, demonstrate that childbirth education conducted in 3 or more sessions is associated with decreased use of planned cesarean birth and increased perception of involvement and satisfaction with decision making during birth. Childbirth education is a widely employed and yet variably implemented intervention, and data from this study suggest that the number of sessions can be used as one indicator of its quality. A Continued Education Unit is featured for this article. The Chaisson et al study, titled "Using a Claims-Based to Identify Severe Maternal Morbidities in a Commercially Insured US Population," uses administrative claims data to measure SMM in the postpartum period. The study identifies substantial geographic variation in potentially preventable SMM events among US states, demonstrating the opportunity to regionally target quality improvement efforts by addressing local risk profiles. It also makes a strong case for including postpartum or post-hospital discharge data in the measurement of SMM.
Equity is the foundation of quality, and the online article by Rochin and colleagues, titled "Perinatal Quality and Equity-Indicators That Address Disparities," details the development of a national dashboard of key maternal and neonatal birth outcomes reported by broad racial and ethnic categories and benchmarked for hospitals to evaluate progress toward reducing racial disparities. Notably, Rochin and colleagues emphasize the role of perinatal and neonatal nurses in leading initiatives to "elevate obstetric and neonatal equity and outcomes."
Patient safety, quality, and risk management are critically important issues to perinatal and neonatal nurses. While the importance of these issues is not new to our Journal of Perinatal & Neonatal Nursing (JPNN) readership, there are increasingly novel measures and approaches used to achieve high-quality patient care outcomes. In this issue of JPNN, we highlight some of the recent work focused on quality indicators. A quality improvement project aimed at increasing the frequency of skin-to-skin contact for extremely low-birth-weight infants is reported by Helen Nation and colleagues. Their article highlights the importance of nursing education and overcoming barriers preventing skin-to-skin care for infants less than 29 weeks' gestational age. Our next article is from authors at the University of Louisville Hospital reporting on human factors to ensure optimal infant identification and abduction prevention within the hospital setting. This article highlights important measures that hospitals can take to prevent the "never event" of infant abduction. Exclusive breastfeeding is a quality measure reported to The Joint Commission, Centers for Disease Control and Prevention, and various public health organizations. In an article from Turkish authors led by Dr Yangin, factors associated with successful exclusive breastfeeding at 6 months postpartum are highlighted and can be translated to other hospitals. Dr August and colleagues from Australia report on fresh perspectives related to hospital-acquired neonatal skin injury prevalence. Their findings resulted from a multicenter study focused on length of stay and patient acuity. Finally, we have many articles that have been published online with this issue. Please be sure to check the journal Web site to see this additional content focused on important neonatal quality outcomes.
As always, we thank our columnists and editorial board members for all that they do to make our journal publications a reality. Without their contributions and support, JPNN would not exist!
-Joyce K. Edmonds, PhD, MPH, RN
-Amber L. Weiseth, DNP, MSN, RNC-OB
Perinatal Guest Editors
-Katherine Gregory, PhD, RN, FAAN
Neonatal Editor